Osteopathic Manipulative Treatment as a Therapeutic Approach for Fibromyalgia: A Systematic Review

Fibromyalgia is a chronic pain disorder characterized by chronic widespread musculoskeletal pain, fatigue, and functional impairment that often remains difficult to manage with conventional therapies alone.Osteopathic manipulative treatment (OMT) is a hands-on, non-pharmacologic approach designed to address somatic dysfunction, but its clinical value in fibromyalgia remains incompletely established.This systematic review examined the association between OMT and pain and functional outcomes in adults with fibromyalgia.A literature search of a single database (PubMed) was conducted using predefined eligibility criteria informed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, although the protocol was not prospectively registered and no formal risk of bias assessment was performed.Six studies involving a total of 258 patients were included.The most frequently studied techniques were myofascial release and muscle energy.Across studies, most reported within-group reductions in pain intensity and improvements in functional status or quality of life, but between-group differences were demonstrated in only two studies; treatment protocols ranged from two sessions to 10 sessions over 12 weeks, the longest assessment point was 180 days, and treatment was delivered by physiotherapists or by non-physician osteopaths in five of six studies.Findings were synthesized narratively, as the heterogeneity of study designs, interventions, practitioners, and outcome reporting precluded meta-analysis.However, the certainty of this evidence is low because of the small number of studies, small sample sizes, heterogeneous designs, and the absence of a formal risk of bias assessment.Because most included studies allowed continued pharmacologic care and only one compared medication with and without OMT, the adjunctive contribution of OMT cannot be separated from that of concurrent drug therapy.These findings should therefore be interpreted as a preliminary, hypothesis-generating signal of potential benefit rather than confirmed evidence of effectiveness.Larger and more rigorous clinical trials with standardized risk of bias assessment are needed to confirm whether OMT is effective for fibromyalgia and to define its role in long-term care.